AccountId: 011433970860
ContactId: 00460ed3-d48d-4390-8f04-ca3e476064b0
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 519340 ms
Total Talk Time (AGENT): 242323 ms
Total Talk Time (CUSTOMER): 90567 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/18/00460ed3-d48d-4390-8f04-ca3e476064b0_20250318T19:38_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yes, I'm calling uh about the status of my claims.
[AGENT][NEUTRAL] OK, I can help you with claim status, sir. Can I please get your name and your policy number?
[CUSTOMER][NEUTRAL] Uh, I don't know my policy number, but my name is [PII].
[AGENT][NEUTRAL] OK Mr. [PII], what is your social security number and that'll pull your policies in for me.
[CUSTOMER][NEUTRAL] Alright, [PII].
[AGENT][NEUTRAL] OK, let me look that up real quick.
[AGENT][NEUTRAL] OK, Mr. [PII], can you please um verify your date of birth for me?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you, sir. And then what is your address, phone number and email address that we have on the policy for you?
[CUSTOMER][NEUTRAL] The address is [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] My phone number is [PII], and my Gmail is [PII].
[AGENT][NEUTRAL] OK, Mr. [PII], it, it appears that I have your work email address.
[CUSTOMER][NEUTRAL] Oh, the work address?
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] Yeah, [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you, sir. I appreciate you verifying all your information for me. OK, you're looking for claim status on uh which policy did you file the claim?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Uh, critical illness and hospitality.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right. Let me look at your critical illness first.
[AGENT][NEUTRAL] OK, and what was the day that you sent the claim information in?
[CUSTOMER][NEUTRAL] Oh, I don't remember the day.
[AGENT][NEUTRAL] I've got the last.
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] The last date that I see is in March, um.
[AGENT][NEUTRAL] And it looks like the claim is still in process.
[CUSTOMER][NEUTRAL] Yeah,
[CUSTOMER][NEUTRAL] Yeah, I sent the uh UBO4.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Detailed billing statement.
[AGENT][NEUTRAL] OK, it looks like the claim is still in process um it looks like they just recently reached out to ask for some medical records.
[AGENT][NEUTRAL] So that one is in progress now.
[AGENT][NEUTRAL] That was for your uh critical illness. Now, let me look at your hospital indemnity where you are with it.
[CUSTOMER][NEUTRAL] Alright.
[AGENT][NEUTRAL] OK, on your hospital indemnity, I do see that we've had, uh, 2 claims.
[AGENT][NEUTRAL] Since January.
[AGENT][NEUTRAL] Did you want the one for January or the one for February?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I didn't know there are 2 of them.
[CUSTOMER][NEUTRAL] I guess both.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me look real quick.
[AGENT][NEUTRAL] OK, so the one from.
[AGENT][NEUTRAL] January that was sent in was for the date of service of [PII] and it was for.
[AGENT][NEUTRAL] Looks like several different.
[AGENT][NEUTRAL] Doctors.
[AGENT][NEUTRAL] From Indian River Hospital.
[AGENT][NEUTRAL] Does that sound like the one you're looking for? OK.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, and it appears that um.
[AGENT][NEUTRAL] We've got a few uh remarks on your claim. Um, the policy does not provide benefits for diagnostic testing.
[AGENT][NEGATIVE] So no benefits were paid for that data service for the diagnostic testing.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, the policy pro provides no benefits for charges made by a doctor for inpatient visits, so it doesn't pay for the physician to come and visit.
[AGENT][NEUTRAL] Um, it's also asking for the itemized hospital bills with the admission and discharge dates.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] That that needs to be sent in still?
[CUSTOMER][NEUTRAL] No, I, I, that's where I sent in the detailed billing statement, the UBO4.
[AGENT][NEUTRAL] OK, so this claim was prior, that was the one from January. Let me look in February after you've sent in your information and see where we are there.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, it just, um, is giving me the remark that uh policy does not provide any benefits for diagnostic testing on that one. And you said that you sent that in.
[AGENT][NEUTRAL] Through the online service center.
[CUSTOMER][NEUTRAL] That was the last thing I sent in.
[AGENT][NEUTRAL] OK, the last thing I show reported was [PII]. Have you sent it since then?
[AGENT][NEUTRAL] Are you there, sir?
[AGENT][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Yeah, I'm here.
[AGENT][NEUTRAL] OK, so have you sent.
[CUSTOMER][NEUTRAL] I don't understand because I.
[CUSTOMER][NEUTRAL] I sent in the UBO4.
[AGENT][NEUTRAL] Right, I'm not
[CUSTOMER][NEUTRAL] The detailed billing statement.
[AGENT][NEUTRAL] OK, I'm not showing anything sent in after [PII].
[AGENT][NEUTRAL] So you might need to resubmit it because it's it's not showing that we have received it. Did you get a confirmation number?
[CUSTOMER][NEUTRAL] No, I, I sent it to our benefits lady here at at Nashmire.
[AGENT][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] I guess the layer on between y'all.
[CUSTOMER][NEUTRAL] And she faxed it to y'all.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right. So, I have not received anything since [PII].
[AGENT][NEUTRAL] So if she's faxed it, she, she's faxed it recently?
[CUSTOMER][NEUTRAL] Yeah, in March.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm not showing that we have received anything. Can you ask her to resubmit it?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] OK, that would be perfect.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, Mr. [PII], is there anything else I can help you with before we go?
[CUSTOMER][NEUTRAL] No, that's it.
[AGENT][POSITIVE] All right. Well, you have a blessed night, sir, and thanks for calling APL.
[CUSTOMER][POSITIVE] Alright, thank you.
[AGENT][POSITIVE] You're welcome, sir.